STONE
BABIES--A Black
Comedy (and a Mystery) About Practicing Medicine in
New York at the Turn of the Millennium

NOW AVAILABLE:ELECTRONPRESS.COM --Downloadable
copies for PCs or PDAs Here, a young doctor discovers some
painful truths about life...at a hospital called "The
Lamb."

Dr. Jay Sones is a young doctor struggling
against the odds to begin a private obstetrical practice
specializing in fertility problems, when he is hit with a
triple whammy. Denied privileges at the upper east side
hospital in whose prestigious infertility lab he was a
star researcher, sued for malpractice, and demoralized by
a near-fatal assault that leaves his partner
brain-damaged, Sones struggles to make ends meet working
in the dreaded outer boroughs of New York City. With one
foot in the glamorous world of his wealthy girlfriend and
the other firmly planted in the poverty and squalor of the
slums where he practices medicine, his suspicions grow
that the three disastrous events are related, and he finds
himself obsessively pursuing the truth. Stone Babies
combines edge-of-the seat suspense with immersion in the
reality of "Labor and Delivery," and provides ironic takes
on the contrasting life styles of Manhattan's Upper East
Side and Brooklyn's slums. Stone Babies is a
medical thriller, a stylish and satiric novel, and an
eye-opening read that leaves the reader with a healthy
skepticism of the goings-on at prestigious hospitals, and
fully educated on the inequality of medical care in this
country.

CHAPTER
1.

[copyrightę2000 by David Hellerstein]

HE AWOKEto heat,
unbearable heat, and the thumping of machinery nearby,
and to one of the nurses calling him to get up, get up,
Room 2 was having late decelerations, and when he stood
he nearly fell over. Must have been asleep all of
twenty minutes, after a night of God knows how many
deliveries, and he was totally dehydrated-reeling, dazed,
bewildered-despite having chugged cup after cup of
lukewarm orange juice all night.

He stumbled, willed himself into awakeness. His greens
were crumpled, and his shoes-when he jammed his feet into
them-were soggy from the madness of last night. How many
babies had he already delivered this shift? Nine? Twelve?
Two babies delivered in the hallway, one in the supply
room. A flood in delivery room number 3. A brownout during
the last C-section that lasted nearly ten minutes-and they
stood there praying that the emergency generator would
kick in before the woman died. And then, while he was
holding the woman's uterus in his hand, the boyfriend, a
cheerful drug dealer, wouldn't stop rapping about how he
had dusted a rival gang member, first shot, then stabbed,
then throttled with bare hands, how he "wouldn' go ta
sleep."

Now Jay came out into the nursing station, blinking at
the red Bronx dawn, and squinted over the chart. It was
stifling out here, palpably hotter than the windowless
call room where he had been sleeping-here you were under
the full glare of the morning sun.

Sister Jolie led him down the long marble-floored
corridor into Delivery. Pulled a mask onto his face, tied
a heavy blue gown behind him. The woman was howling, and
when he came around the table he began howling too: the
umbilical cord hung down between her legs. Prolapsed.

Get oxygen, 100%!

There's no oxygen, doctor, Sister Jolie responded.

Then we've gotta set up for a C-section.

I don't have the staff. No anesthesiologist. Only two
nurses for the whole floor.

Then what am I supposed to do?

Deliver it fast.

He did. Rather, the mother did. Reacting to the heat,
the screaming and clanging, she grabbed the sides of the
delivery table, and with a great rush of fluid expelled
her child into Jay's midsection.

Meconium! Fetal distress! Jay roared. Where's
pediatrics?

Not in yet! shouted Sister Jolie.

He stopped swiping at the mother's wet bottom and turned
his attention to the baby, searching for some kind of
suction apparatus. He fell back on holding the baby upside
down, ripping off his gloves and sticking a bare,
none-too-sterile finger into its toothless mouth, then
smacking it until it wailed.

"All right!" he whooped, euphoric, crazily ecstatic.

The mother wept in gratitude. Drenched in sweat, Jay
leaned over and presented the glistening purplish-black
infant to her.

"A perfect baby boy!"

He nearly passed out: the mother, with puffy tearstained
face, and neat pink barrettes holding back cornrow braids,
was a girl no more than 14 years old.

That was how the day began: in Hell.

It didn't help that the air conditioning at Sacred Lamb
Hospital had died weeks ago. Early summer had been mostly
cool and overcast, so the AC had hardly been missed; but
now, the last week of August, 1991, a record heat wave had
surged through the New York area, and halted once its
epicenter reached Jerome Avenue. Up and down the Cross
Bronx Expressway, angry motorists cursed outside their
stalled cars; in the streets below, half-naked brown
bodies splashed through the few still-spurting hydrants.
EMS workers pulled octogenarians, shriveled and delirious,
from steaming brick tenements. And day and night, the
gleeful rattle of automatic weapons echoed through the
streets.

The tropical front-bloated and overheated as the
nation's post-Crash economy-billowed and swelled until the
tall, ugly, yellow-brick Victorian buildings of Sacred
Lamb Hospital shimmered like bakery ovens. Stifling was
hardly the word-it was more as if the Sun herself rested
gently against the hospital's leaky old mansard roofs,
incubating some mutant offspring into the wretched
landscape of the South Bronx.

<><><><><><><><><><><><><><><><><><><><><><><>

"Well, look who's here! Back from the heart of
darkness!"

Becky Okum, Eurobond trader, squealed and zoomed over to
hug Jay. Her husband Mike, star of the initial public
offering markets, punched his shoulder.

The cool, cool darkness of Janine Stern's apartment.
Full of friends.

Edmundo Jarquet and Jakki Furagama sitting on the couch
discussing the Mets-or was it The Met? Louise Encard, New
York Post Page Six reporter and tireless busybody,
emerging from the dining room with a radicchio and endive
salad and running over to kiss him. And Janine Stern, gold
earrings and sequined blouse glittering-her black hair
pulled straight back, her skin seared to almost Iroquois
darkness-rushing forward to kiss Jay juicily on the mouth.

It was a great party, a perfect release from months of
L&D, from the entire past year. The past year's
disasters had been followed by months of isolation-and
then, when reality set in, when Jay realized the enormity
of his commitments and the precariousness of his finances,
by panic. First there was the lawsuit. Then Alli. And then
the mess around his application for hospital privileges at
Manhattan Medical Center. And afterward, months of
frenzied attempts (by moonlighting at one hospital and
clinic after another) to pay his malpractice premiums and
the overhead on his Park Avenue office. Recently, though,
Jay had begun to stanch the rapid outflow of funds. Not
entirely-the waiting area in his Park Avenue office was
still empty most hours-but at least business had grown to
the point where he could pay the interest on the interest
on his loans. And cover his receptionist's and nurse's
salaries, and have enough left over to gas up his Subaru.

Which called for celebration.

Janine's party was a perfect way to revel. The CD player
reverberated with Talking Heads, hazy partygoers danced on
the terrace, a startling bouquet made the air glow above
the Steinway baby grand, and the dining table sang with
artful arrangements of mesquite-broiled shrimp and
chalupas, and the charred flesh of endangered aquatic
species, and crystal bowls of ceviche and guacamole. It
was perfect. Everything he had missed during his endless
years of medical training, everything he had yearned for
throughout his Queens adolescence-all the riches of
Manhattan, and more.

Lustful vapors filled the air-conditioned,
high-ceilinged rooms of Janine's apartment. Everyone
looked stunning, tanned, prosperous, at least five years
younger than their birth certificates would allow.
Especially Janine Stern-she looked not only more graceful
and lithe than ever, but also more desirable than Jay
recalled; less calculated and over-deliberate as the more
cognizant parts of his cerebrum usually knew her to be.
Dare he think it-she even looked sexy.

The exception to this glamour was Jay Sones, MD. Jay
caught a glimpse of himself in the antique gilt-framed
mirror over the dining room buffet, saw shards of Sonian
flesh in a crystal obelisk that rose above the flowers on
the piano. The good doctor looked stubby and disreputable,
even diseased. His complexion was saturnine.

Ducking into a bathroom, Jay scrubbed the South Bronx
off his face-the fifteen year old, pregnant by her
stepfather; the young mother riddled with syphilitic
lesions, giving birth to a twitchy coke baby; the
thirty-three year old multiple rape victim who had watched
her husband murdered; the five months pregnant speedball
junkie, no prenatal care, popping out a 1500 gram baby
girl . . . Jay's face reflected The Lamb. He slapped his
cheeks to introduce some color. A futile attempt, however;
he looked merely bruised.

On his way back into the party, Elly Townsend, a blond
tax lawyer, pulled Jay aside to ask some medical advice.

"Sorry to bother you," she said nervously, "but I'm
really scared."

Black silk rubbed his bare forearms. Jay took her hand.

"Last weekend," she said, "I bumped myself working out.
In the shower I noticed . . . not only did it hurt, but
now . . . now this lump was growing." She inhaled
sharply. "Can-can I ask your opinion?"

He followed her into Janine's study. A huge aquarium,
phosphorescent with fish, cast tremulous turquoise shadows
across them. Elly pulled aside the strap of her dress. Her
lovely shoulder was warm in his right hand; he reached out
and touched her bare, lovely breast with his left. A hard
bump rose beside the nipple-mobile, exquisitely tender.
She looked fearful.

"Nothing," he said at last, "nothing but cellulitis."

As he described the remedy-warm soaks, heat, Advil-her
anxiety began to fade.

"If it doesn't get better in a few days, give me a
call," advised Jay. "You might need a prescription." While
she readjusted her dress he reached into his suit-jacket
pocket, where he kept a thick stack of engraved business
cards for just such eventualities. He peeled one off. He
was sweating. "I think maybe I have . . . yeah, here's one
of my cards. Give a call if it's not better by Monday."

"There you are! Turning my study into a satellite
clinic!" Suddenly Janine was at Jay's side, grabbing his
shoulder. "Elly, watch yourself with this man! He comes to
parties claiming to be a doctor, he takes girls away to examine,
and they're usually found floating in the East River!"

Elly winked at Jay, and Janine dragged him back into a
glare of halogen and crystal.

"Honestly, Jay, please don't seduce my guests!"

Jay leaned forward and kissed her.

Janine's arm stayed around him for most of the evening,
though Donna Hastings, who bought oil tankers for Chemical
Bank, dragged Jay off to ask about PMS., Anne Fellowes, an
historian, needed a refill of birth control pills, and a
platinum-blond music video producer whose name he couldn't
quite catch had a litany of worries about her fibroids. By
midnight the stack of business cards had become noticeably
smaller without considerable effort on Jay's part. After
each foray Jay would return to Janine's side and she would
put a proprietary arm back around him. Around two o'clock
the guests left.

Then, for the first time in fifteen months, Jay and
Janine made love.

The only way to describe making love with Janine Stern
was that it was like being acquired by a corporate raider.
That is, having been carefully scrutinized and evaluated,
your balance sheet toted up, your liabilities shrewdly
estimated, your future growth potential researched, after
courtship and tender offers, your assets were suddenly
seized, whether you were ready or not. And yes of course
you would like it, because suddenly bought out, you were
floating in gold.

Anyhow, that was the fantasy, the promise. Actually,
their love-making that night was rather awkward-he was
exhausted, she was wired, jittery-and their final sweaty
ecstasy felt earned, not given.

<><><><><><><><><><><><><><><><><><><><><><><>

Jay flipped over to the other line. "Anyhow, Vince-to
continue. About six o'clock Sunday morning Mrs. Valley
finally gets to the ER. She waits two hours to be seen by
the ER doc-not Bharig, who's gone off duty, but some
Iranian guy-Haradim, I think. Haradim doesn't put in an
IV, he doesn't get the nurses to follow her vital signs,
he just leaves her in a room waiting for Cowell. And just
as he's getting ready to see her she arrests. Haradim
tries to resuscitate her, he calls the doc covering the
ICU, who is equally stupid and just puts in a tiny
peripheral IV. And then I'm unlucky enough to come walking
through the door."

And Jay went though the whole gruesome tale. How he had
arrived at the ER, taken over. Put in a central line,
hydrated her, ordered stat blood, paged anesthesia, got
her into the OR. How Cowell, the general surgeon, finally
showed up.

"She live?"

"Just barely. She had a complicated post-op course, had
peritonitis, abscesses, all that. Had to be transferred
over to MMC, where they have a decent intensive care unit.
Had drains in her belly for a few months. Drains means
little plastic tubes so the fluid can drain out-you pull
them out a few centimeters a day. Lets a track develop so
the wound will heal."

"But she was okay."

"Except for one thing. Lost her uterus. Ergo, no babies.
Ever."

"So what was the flaw in her treatment?"

"No flaws really. Beside that two day delay before she
agreed to come in to be seen. Well, maybe things were a
little disorganized once she did show up in the ER. But
Haradim was waiting for Cowell. Basically what he
did is standard procedure at The Ghost-keep your hands off
the patient until the big shot private Attending gets
there. The real flaw is that Witt probably shouldn't have
given her X-11Q during the implantation. It was still
experimental; only patients in the protocol were supposed
to get it. Maybe fifty or sixty women had received it-and
they were all followed under controlled conditions . . .
nobody really knew the complication rate."

"What about the IFGR procedure itself? You think Dr.
Witt could have screwed that up?"

"I don't know if screwed up is the word. It's possible
he poked the catheter through the wall of the fallopian
tube or lacerated a blood vessel. But she was okay for
three months, so it seems doubtful."

"So they're just naming you as one of the accessory
physicians?"

"I think so. I assume Cowell and Witt and Bharig and Yao
and everyone else will be getting letters too. I mean, I
don't think I would have done anything else differently if
it happened over again. Maybe just insist that she come to
the hospital immediately Friday morning, or get the
husband to bring her. But that's it."

"What's she suing for?"

"How much money? I have no idea."

"That too. But I mean what reason? Is she angry
at Witt or The Ghost or does she want revenge for the pain
and suffering or what?"

"I couldn't tell you."

"Well, you'll find out eventually," Vince said.

<><><><><><><><><><><><><><><><><><><><><><><>

And so it was that day, on entering the laboratory, that
Jay immediately perceived how much was amiss, in an
extreme of disorder, and only gradually was able to give
it a name, a label, and then to act in a rational way.
Possibly, in retrospect, he concluded, because it was so
unexpected, so horrific. His first thought, entirely
nonsensical, was: Usually doctors commit the violence
in hospitals! For the sight of blood, blood
everywhere through the lab, red-purplish, blackened,
puddled across countertops, chairs, computer keyboards,
laboratory equipment-all made him think immediately of the
operating room and its associated violence, generally
committed in the service of healing.

Then-and it must have been only two or three
seconds-came the shock of naming, and a sudden airless
terror as the word "murder" entered his mind. And
half-recalled stories about the occasional terrifying
attacks on hospital staff members by deranged patients, by
intruders, by rapists, by thieves interrupted.

He saw her.

She was lying on the linoleum. Right below her computer,
on whose screen flickered a black and white image of naked
babies, cherubs, floating in space. Her head was black
with blood. Her hands clasped something. Her clothes-

The miracle only slowly dawned on him; she was
breathing. His hand went to her sticky, blood-slicked
neck, her naked shoulder. He felt a pulse.

And then something automatic, entirely without feeling
or sensation, took over, and he did all the things that a
doctor might be expected to do in such a situation.
Checked her airway. Began CPR. Grabbing a telephone,
dialed in to call a Code. Watched frantically as the
silent surface of early morning, the majestic calm of the
hospital and the ordered rush of doctors and nurses coming
to work, was interrupted by a horrible discordance, a
ragged, urgent invasion of pallid men and women-friends,
colleagues-throwing aside their paper bags of breakfast,
their coffee cups, screaming for intubation tubes, for
oxygen. For a stretcher.

He was no use in this: stood aside, near the
blood-spattered computer printouts. Slumped finally onto a
laboratory stool. Heeded from a great distance the
imprecations of Security officers-and the New York City
police officers-to touch nothing.

As though that mattered: there were bloody footprints
everywhere. Needle and IV wrappings, blue chux pads, coils
of tubing, stepped-on EKG tape. He dully noted that she
was no longer in the room, and then became aware that
familiar faces stood before him-Linda, the chief
Infertility Lab technician, Turin, Wei Li, others, most in
tears, and he discovered to his surprise, he too was in
tears. And that a police officer, who had, oddly enough,
only three fingers on his left hand, was speaking to him.
No matter what he did, he couldn't catch his breath.

<><><><><><><><><><><><><><><><><><><><><><><>

Around the corner, Jay opened the trunk of his Subaru
and tossed the athletic bag and squash racquet inside.
Then he turned the motor over and ground the old
transmission into Drive, and following Eddie Polito's
directions he headed East across one of the lesser East
River bridges and into the immensity of Brooklyn.

Immediately he got lost. Around one o'clock, after
stopping in several gas stations, Jay finally pulled up
before a brick-and-plate-glass storefront which had a
large blue and white plastic sign:

BROOKLYN WOMAN'S CLINIC, EDDIE AND TONY
POLITO, DIRECTORS.

Stretched across the front window was a banner reading:

LADIES! MUJERES!

COME IN TODAY!!!

FOR YOUR FREE PHYSICAL!!

Jay walked in.

Brooklyn Woman's Clinic's waiting room trembled with
concupiscence. Enormous Haitian ladies in tent-like
dresses and gaunt Chinese women with swollen bellies and
plump Hispanic girls in stretch pants-sitting on folding
metal chairs, leaning against cast iron columns, trading
gossip, applying eye makeup, complaining about their heavy
bellies and their aching feet, juggling and cooing at
their wailing infants, screaming at the innumerable
toddlers that crawled around them on the floor.

A man approached. He wore a white coat whose seams were
strained to the limit by his enormous free-weight biceps
and barrel-chest.

"Hey there! Gomez! Am I glad to see you!"

"Sones," responded Jay.

"Sorry, gotcha confused with one'a those Puerto Rican
fellas. C'mon in, Dr. Somez. I'm Eddie Polito, medical
director of Brooklyn Woman's, my brother Tony is the chief
financial officer-he went out for lunch, but he oughta be
back before you leave. C'mon back, let me show you your
office. We got patients up the wazoo!"

He led Jay back through the store, between glass
counters that looked like they once held huge slabs of
beef, to the offices. There were five or six tiny exam
rooms on one side, each with an examining table, and along
the other wall an antique weighing scale and
sphygmomanometer, and a shelf of plastic laundry tubs
containing a seemingly random assortment of glassware,
syringes, plastic specimen containers, cotton balls and
culture swabs. Apparently, overhead was low.

A plump gum-chewing Filipino girl in a pink smock was
taking the blood pressure of a Hasidic woman. Polito
snapped his fingers to get her attention.

"Corinne, want you to meet our new Wednesday doc. Doctor
Somez."

"How d'ya do," Jay said.

Corinne smiled wetly. She removed the blood pressure
cuff and waved the patient in the direction of the
examining rooms. Jay stared at her: she was not using a
stethoscope. You could not get a blood pressure without a
stethoscope. Moreover, you cuffed the upper arm, not the
forearm.

"Corinne, show Dr. Somez where the prescription forms
and lab slips are, and get him a stack of Medicaid forms.
And tell Candida to put patients in all the rooms."

Corinne waddled out front. In a few minutes Candida, a
frail bluish-skinned Dominican woman also in a pink smock,
began herding patients from the front room into the tiny
examining cubicles.

"Now," Eddie said, "c'mon back to my office, we'll talk
business." He shepherded Jay through a heavy metal door
into the furthest-back room. Paneled in white plywood, it
had a large desk on which rested a TV, a VCR, three
telephones, and a pile of magazine clippings. Faded
Penthouse calendars were tacked to the walls. He motioned
Jay down on the couch. "This'll take a minute, then you
can get started. Here's the rules. You work five or ten
hour shifts, minimum of ten hours a week. You buy your own
malpractice. Worry about your own benefits. And I pay
sixty bucks an hour, cash."

"You said seventy-five," Jay said.

"Today you get seventy-five for helping me out, but I
can only afford sixty." There was a pause. "Look, sixty is
good money. Take it or shake it."

Jay stood. "It's not enough. It takes too long for me to
get out here, it's not worth it for sixty."

"Hey! Don't get frustrated and leave. Tell you
what-listen, Dr. Som-ez, you can make more than that. A
lot more. We've got a bonus system-just listen, let me
tell you about it, then you can decide. I'll pay you
sixty-five if you want straight cash, but sixty in the
bonus system will bring you a lot more."

"Shoot," Jay said.

"Okay, here's how it works." Eddie went through it, the
way he and Tony had set it up. There was a bonus for
seeing more than a certain number of patients a day. Plus
an incentive system, where Jay would get a dollar for
every lab test he ordered-bloods were drawn down the block
at a lab that Anthony and some of his friends owned. For
x-rays, there was an arrangement with a fella on DeKalb
Avenue. Also, if he steered patients toward his cousin
Ricci's pharmacy on the corner of Flatbush instead of the
discount Buy-Rite, then there'd be a little extra bonus, a
five or ten dollar bill every shift. "Now, these are poor
people, unhealthy people, right?"

"Yeah."

"So we figure that they need lots of blood tests,
because something serious might be wrong, y'never know.
They need lots of medicines too. Plus, we know that the
generics aren't any good-so we give brand name medicines,
because they work better."

Jay must have looked dubious, because Eddie continued:

"You work it however you want. Take it from me, the
extras can only help. And ultrasounds-you know, the Indian
fella who just quit, he found a couple ovary cancers by
getting ultrasounds on everybody. We're doing good here,
Dr. Somez. 'Do good and do great!'-know what I mean? Tony
and me, we realized this is a growth area, medicine, as
long as you set your clinics up right and see a lotta
patients. An excellent business. We'll be setting up
clinics all over Brooklyn before you know it, and if you
want work, Somez, we can keep you busy twenty-four hours a
day. Maybe you could even be Medical Director some day."

Jay smiled. Really, what Eddie was saying didn't seem a
whole lot different than the talk you heard in the
hallways at MMC. All those new Harvard MBA types with
their slicked-back hair and yellow ties-if you actually
listened to them in the elevator they'd be talking about
"vertical integration of health services," and "maximizing
reimbursement by optimal CPT coding," and "strategies for
shortening length of stay." Same shit, different words.

"You been doing this for a long time?" Jay asked.

"Just two years. We come from construction, contracting,
and before that, rubbish cartin'. Construction, that's a
good business too, but too cyclical, too many ups and
downs . . . To be honest, doc, this one's got more
potential. Most MDs in the community, they don't know how
to run a business." Polito stretched, and did a sudden
air-karate punch. "Oos! Anyhow, enough warblin', you got
patients out there. Go for it!"

Jay walked out and began shuttling from one tiny
curtained alcove to another. He showed Corinne the proper
way to take blood pressures, and even poked his head out
every so often to see that she was still using the
stethoscope. He showed Candida how to set the patients up
on the examining tables, how to drape them, how to get
their feet in the stirrups, their bottoms just over the
edge of the table, how to set up the speculums and cotton
swabs and culture tubes close at hand, and the basics of
instructing in breast self-examination.

At ten p.m. he scrubbed his hands one last time, and
pulled on his jacket. Jay hurried past the bodega next
door, where a group of home boys stood staring down the
passers-by. He crossed the boulevard which echoed with the
roar of mufflerless cars and gunned the motor of his
Subaru, all too conscious of the fact that he was carrying
in his front pocket a grimy white envelope with seven
hundred fifty dollars in cash.

BATTLES OF LIFE AND
DEATH--Award-Winning Essays
About the Education of a Young DoctorBY DAVID HELLERSTEIN, MDPublished by Houghton
Mifflin (hardcover), Warner Books (paperback)

AVAILABLE AT:
AMAZON.COM --Discount priceThe following excerpt, from the
prize-winning essay "Touching,"
tells about the mysteries of the gynecology clinic

[copyrightę2000 by David Hellerstein]

"SCOOT
down to the edge of the table, hon," says Dr.
Snarr. The small room is hot, the air stuffy. Our
patient winces at the word hon. She is a young woman
with chronic pelvic pain, the bane of gynecologists, and
I can tell she doesn't like Snarr's tone. She does scoot
along the table, though, and Snarr kicks the wheeled
stool toward me. I sit on it, slide between her legs,
ready for my lesson of the day. Feet and calves and
thighs surround me, suddenly very close. Snarr positions
the lamp before my chest, so light pours on her. I warm
the speculum in my gloved hand and, with a twist, insert
it.
"Open it up," he says. "Tighten it
all the way open. Pull down to keep away from the
urethra. You hit the urethra and no patient will ever
come back to you."
Snarr is my teacher, a gaunt and
narrow-shouldered man with a small potbelly below the
belt of his corduroy pants. Before coming in here, he
went over the information I had gathered and insisted it
was nonsense. She couldn't possibly feel that kind of
pain. I must not be asking the right questions. Hadn't I
learned anything? Gynecologists traditionally have
the reputation of being the dummies of medicine:
surgeons laugh at their clumsiness in the operating
room, internists at their ignorance of medical fact,
psychiatrists at their insensitivity.
And so far Snarr had done nothing to
dispel that prejudice, which was too bad, considering
that I was an impressionable third-year medical student,
still trying to decide what field to select.
"Okay," says Snarr. "Now swab it out
real well. Get some cells on that."
I swab.
"Pull that speculum out now. Get a
good look at those walls."
I see pink folds as I pull, pink,
moist walls bulging against the metal of the speculum -
aquatic territory, the scalloped forms of submarine
life. It's out. Snarr is quick next with lu bricating
jelly on the first two fingers of my glove. I stand up,
push the stool away. I begin the manual exam.
"Aiee!" The woman screams and slides
up on the table. "God! Oh God!"
"So that's . . . that's where it
hurts," I say. I'm sweating. "Just. . . just a second,
I'll try more gently."
I feel around again. This time she
doesn't scream. She breathes deeply. I can't feel a damn
thing, but with Snarr watching I can't pull out right
away. For a month I've been spending afternoons in the
gynecology clinic with Dr. Snarr -a month of women's
bottoms on the edges of tables, of the hot lamp in front
of my chest, the examining glove on my hand, powdered
inside, the smells of femaleness. And the confidences of
women, fascinating and at times overpowering, about
their pains, their periods, their fertility, their
husbands, their lovers. What gets to me, though, are the
exams. The touching. Deep internal touching, feeling for
the bulge of the uterus, for those small elusive olives
the ovaries, exploring for tenderness, creating sudden
moments of pain. Technically I'm reasonably good, as
good as can be expected for a third-year medical student
rotating through Ob-Gyn. But I still find it strange to
be touching intimately but without passion--as a doctor.
#
#
#
#
#
"All right," Dr. Snarr says, "let me try my hand." He
steps in. I strip off my glove and wash my hands, ready
to observe a deft exam, pinpointing the source of pain,
exploring yet reassuring.
But in a second the woman is
screaming, writhing on the table. Snarr is reaching way
far in, clumsily it seems, pushing so hard her hips rise
from the table; and she is crying, grabbing the table
with her hands. I feel sick just watching. I have no way
of knowing what, if anything, Snarr is finding, since he
does not explain.
"All right, hon," he tells her. He
pulls off his glove. "Wipe yourself off; we'll come back
and see you in a minute.
"I don't know why the heck she
hurts," he says when we are outside. "Give her some
estrogen cream."
She'd dressed when I come back in.
She's pale and woozy, and there's still pain in her
eyes. I hand her the prescription.
"Come back if it gets worse," I say.
"Than what?" the woman asks.
I am embarrassed. I murmur
something, that I'm sorry we didn't come up with
anything. Then I hurry out after my teacher.
I find him in the side room, having
coffee and doughnuts, courtesy of the pharmaceutical
rep. The next patient isn't ready yet.
"Have some," he says.
I decline. I'm too jittery to eat.
"That girl," says Dr. Snarr. "What
do you think her problem is?"

BATTLES OF LIFE
AND DEATH--Award-Winning Essays
About the Education of a Young DoctorBY DAVID HELLERSTEIN, MDPublished by Houghton
Mifflin (hardcover), Warner Books (paperback)

AVAILABLE AT:
AMAZON.COM --Discount priceHere, in an excerpt from the essay "The Battle for the Dead," a young
doctor struggles with a patient's family to get
permission for an autopsy (the Post, or postmortem
exam)...to find out why his patient died....

[copyrightę2000 by David Hellerstein]

"NOW
comes the real question," said our chief resident.
"How do you get the post?"
It was noontime in July, a few days
after internship had started, and we, the new interns,
had been called down to the Medicine Library for lunch.
Through the chief's introductory remarks about the
importance of the autopsy in the progress of medical
science, we ate sandwiches and drank Cokes and dozed and
looked out dusty windows at the inaccessible sky.
The chief introduced his buddy Jerry, one of the
other residents. He was stocky, with a mustache,
in rumpled whites. Now we woke. What we
needed was not history but this, nuts and bolts.
After all, we were the ones who, at 3:00 a.m., had
to ask for a signature on a consent-to-autopsy form, and
we were the ones blamed for failure on rounds the next
morning. You didn't get the post on Mrs. Jacobs?
We wanted it, you know.
"Number one," said Jerry, "when you
ask the family for the post, don't reason with them.
It's a waste of time. If you talk about the
progress of science they'll walk out the door.
Instead, listen to what they're saying.
Whatever it is, agree one hundred percent.
They always say one thing: 'He's suffered enough.'
If you're rational, you'll say, 'What, are you
crazy? He's dead. How the hell's an autopsy going
to make him suffer anymore?' And they'll walk out
the door. Instead, say, 'He did suffer enough.
You're right. And I'll make sure he won't
suffer anymore.'"
One of us interns had a question.
"Just how do you keep the dead guy from suffering? Don't
they ask that?"
# #
# #
On rounds the next morning, another
resident asked what had happened. I explained how
none of Jerry's techniques had made any difference.
He shook his head; it was one of the minor
disappointments of the day.
"Too bad. We wanted it, you
know." Then he grinned. "Did you try the
gold ball story?"
"What's that?"
"You tell the family that just
before the patient died you had him swallow a gold ball
and now it's stuck inside. The gold ball is worth
five thousand dollars, and if you don't do the autopsy
it's added to the hospital bill."
"That's sick," I said. "Who would
say that?"
"Well, did you get the post?"
"No, the damn coroner gave in."
"They always do," he said.
"They won't fight the family. It's up to you
to get it."
"I know," I said. "Next time I
will."
#
#
#
#

In this excerpt from "Loving
Touches," Dr. Pete Roth comes to work and has a
surprise that will change his life...

[copyrightę2000 by David Hellerstein]

"WILL
Dr. Potanik please fetch the patient?"
Potanik fled.
An oppressive silence grew in the
conference room. Pete looked at Whitehouse's
bland Pollyanna features and at the conniving Rivkin,
and for a moment over at Dr. McGrath, plump and
pock-faced, impassive in the corner, who for all his
silence was more malignant than Tapir. Tapir
just made noise, just toyed with you for pleasure,
while McGrath was rumored to go for total destruction.
It was also rumored that McGrath, having had his
last several research grants "approved but not
funded," was close to being exiled to the VA; true or
not, this hadn't improved his temperament.
"You, Roth."
"Sorry?"
"Dr. Roth will interview."
The door opened, and Pete, whose
mind had been drifting back to the Montauk beach where
he had spent a delightful week with his wife Sarah,
sat forward. Rotund Potanik led the way, and
Mrs. Zimhof followed. She was attractive but not
beautiful, with a clear complexion and blond hair that
came to her shoulders; her tanned arms were wrapped at
the wrists with gauze pads, whose whiteness was a
shocking contrast to the dark, healthy glow of her
skin. What was underneath them what slices or
gouges, Pete didn't want to know.
"Mrs. Zimhof?" He stood.
She turned to face him, and simultaneously they
started. "I'm Dr. Roth."
Later, he would regret everything
from that moment on, but he was so stunned, so amazed,
so bewildered and so angry that it was all he could do
not to throw his arms around her, asking how on earth
she had gotten here to Curtiss's eighth floor, where
she had been for the past two years, where she'd disappeared
to. All he could do was stand there, gawking,
until a rustle of papers reminded him of what was
supposed to happen next.
She sat down. He moved his
chair a few inches farther away and sank into it.

What could he say? What
could he say to Mrs. Zimhof, to Celine Walter--for
that was who she was, Celine Walter from across town,
Park Avenue and Seventy-ninth, Harvard Graduate School
of Arts and Sciences--who, when he was a medical
student and she an Adams House tutor, he had pursued
and slept with and desired infinitely--and who had
disappeared. What could he say to her that would
not incriminate himself and reveal more of his own
pathology than hers?
Dr. Whitehouse was smiling,
gaining with each moment of silence. Dr. Potanik
stopped shuffling his papers. Dr. Tapir sucked
his pipe. And Dr. McGrath slowly twisted in his
chair.
What could he say?....What the
hell happened to you, Celine Walter? How about that?

A
history of American medicine as seen through 5
generations of doctors in one American family.

Reviewers say:

"Rewarding reading...an artful blend of medical
history and family memoir."
(Kirkus
Reviews)

"His remarkable family memoir is at once the
remembrance of American medicine past and a hopeful sign
of its future..."
(Gerald
Weissmann, MD)

"A marvel of family, medical, and personal history
interwoven into a seamless saga I couldn't tear myself
away from."
(Sherwin
Nuland, MD, author of How We Die)

Here, in an excerpt from
Chapter 5, "The Golden Age," a
young military doctor provides care on the front
lines in WWII....

[copyrightę2000 by David
Hellerstein]

It was September 6, 1944, and
he was twenty-eight years old, commander of a medical
detachment of twenty-three men assigned to the 40th
Tank Battalion of the 7th Armored Division of General
Patton's Third Army, stationed on the front lines in
the town of Ste-Marie-aux-Chenes, France.
They had set up a temporary aid station in the cellar
and first floor of a wrecked farmhouse. Across the
stone floors lay American tank soldiers and
infantrymen on stretchers, thirty of them, their
bodies torn by shrapnel and gunshot, by mortar fire
and deep burns. ...I can just imagine my father
working among them...I can see the set of his jaw, his
intent expression, the force of every gesture, and I
can hear his voice angrily barking orders to the
medics, and turning soothing and reassuring as he
spoke to the wounded...
#
#
#
#

From this story and its
variants...comes the image that haunted me as a child;
indeed, one that haunts me even now: my father, the
young doctor, the young soldier, standing atop a
crippled tank, carefully hauling a wounded soldier
feet-first into smoke and gunfire on a European
battlefield. As a kid...we would drag my father's
army uniforms out of the attic closet and lay out his
collection of German bayonets. Then we would find him
downstairs and insist that he tell his war stories once
again.

Here, in an excerpt from
Chapter 9, "Training Years,"
an account of becoming a doctor at the end of the
20th century....

Night and day we inhabited the huge
Medical Center building, and we came to know its endless
hallways and windblown courtyards and vending machines
and intensive-care units and operating rooms the way we
were coming to know the human body. Many weekends we
spent in the library, looking out at the shimmering
green of wind blowing through the trees, hearing the
endless twittering of unseen flocks of birds, looking up
periodically from our stack of photocopied reprints as
blue patches of untouchable sky turned dark with the
coming of night, and many nights we were awake on
the hospital corridors, seeing one shift of nurses leave
and the next arrive. With the barest of
skills, we grappled to understand the medical universe
we would have to face for the next fifty years, and we
struggled, like centuries of doctors before us, to claim
a part of it for ourselves.

.......As a third year medical student I
chose an elective rotation on the cardiovascular surgery
service run by Dr. Norman Shumway. ...One day I
stood in the operating suite, tottering atop three metal
stools like some character out of Dr. Seuss, watching
Dr. Shumway transplant a heart. From my unsteady
perch I peered down into the operative field, as Dr.
Shumway clamped the aorta and the heart-lung machine
took over the circulatory functions. I watched as
the diseased, fatty heart was removed and dropped into a
basin. Then I gazed into the patient's empty chest
and was overcome with a profound, even visceral sense of
shock. This empty space, this heart cavity without
a heart, belonged to a human being who was still
alive.... The new heart, warming, soon began to beat,
the chest was closed and the patient was wheeled out of
the operating room to begin an uneventful recovery.